In Somalia, UNICEF-supported programme treats malnutrition before it becomes life-threatening

Filsan Yusuf, a health worker at the Outpatient Therapeutic Clinic in Hargeisa, hands a mother portions of Plumpy’nut food supplement. Severely malnourished children are monitored on a weekly basis and are treated with the high-energy peanut paste to bring them back to health.

By Mike Pflanz

HARGEISA, Somalia, 30 December 2010 – Salman Haji, 4, stands in the corner of a tin-walled hut, solemnly staring at the man in the white coat as he searches through an impressive amount of official looking paper spread across a large table in a seemingly random fashion. Eventually, a yellow medical card is found recording the details of Salman’s last visit to this mobile clinic, located on the outskirts of Hargeisa.

“He was improving, but now there are signs again of malnutrition, and of an underlying chronic respiratory illness,” Ali Mayag Muse explains to Salman’s mother, Hodan Mohamed, as her son struggles to contain a sudden coughing fit.

UNICEF provides support

Mr. Muse is a supervisor at an innovative Outpatient Therapeutic Programme which aims to treat children before malnutrition becomes so severe that other deadly illnesses - tuberculosis, diarrhoea and pneumonia chief among them - can take hold. The project is supported by UNICEF, and is funded by the European Commission Humanitarian Aid Department (ECHO), UK Department for International Development (DfID), Governments of Italy, Spain, and Denmark, as well as the Italian and French National Committees for UNICEF.

A child eats Plumpy’nut after his mother bought him to a mobile clinic in Hargeisa, Somalialand. The high-energy, high-protein peanut paste is formulated to treat severe malnutrition.

The weight and height of the children are measured, as is the circumference of their upper arms, to create a weekly snapshot of each child’s nutrition status, which is then checked against records from previous visits. In addition, Plumpy’nut - a pre-packaged high-nutritional quality peanut paste specially formulated to treat severe acute malnutrition - is handed out, as are Vitamin A supplements and zinc tablets to treat diarrhoea. Children with underlying complaints, like Salman, may be started on a course of antibiotics.

In the first ten months of 2010, 90 per cent of the more than 6,000 children treated in Somaliland for severe acute malnutrition recovered. Unfortunately, UNICEF estimates only half of those in need can be reached.

Measured interventions

Asha Mohamed’s nine-month-old daughter, Ayan, was one of those still beyond the reach of the programme, in their remote village a 24-hour journey to the south of Hargeisa.

“She was sick for a month, and getting worse and worse,” Ms. Mohamed says. “Finally, I made the decision on my own to get a truck to come to Hargeisa. It was a day and a night on the road, and Ayan was so sick and exhausted. We were told to come here, and now she is recovering so fast.”

A baby is weighed at a special ward for critically malnourished children at the Hargeisa Group Hospital in Somaliland. Severely malnourished children with medical complications are provided with round-the-clock special care at the UNICEF-supported stabilisation centre.

Little Ayan received her treatment at a special ward supported by UNICEF in the Hargeisa Group Hospital. It is one of Somaliland’s three ‘stabilisation centres’ for inpatient treatment, the step above the outpatient programme for the most serious cases. The infants must be slowly brought back to strength with measured interventions.

“It can kill a malnourished child to rush in to treat the malnutrition, first we need to treat the complications,” said supervisor Hawale Abdullahi.

Hope for expansion

Approximately forty cases are admitted to the centre each month, but Mr. Abdullahi has hope that those numbers will drop if the outpatient programme can be expanded.

“Children can deteriorate so quickly to the point where their severe malnutrition is difficult to manage,” he explains. “That’s why the stabilisation centres are there, but it’s also why we are trying to widen the reach of the outpatient programme, to catch children before complications set in.”